Pregnancy Pains and Preparing for Childbirth with ‘The Vagina Whisperer’, Sara Reardon

that support your vagina. Along with your uterus, your bladder, and your bowels, your pelvic floor muscles. Not surprisingly, your pelvic floor muscles are pretty pivotal when you're pregnant and when there's a lot more that meets supporting. And even if your baby doesn't end up exiting the building via your vagina, pregnancy can take a toll on your pelvic floor. Pee when you laugh for cough, had hip back, pelvic or pubic pain or pressure, that's your pelvic floor muscles talking.

It's time to listen up and to listen to today's guest. You may have heard of the vagina Whisperer, but her real name is Sarah Reardon, and she's a pelvic floor therapist and she's a mom of two boys, so she and her pelvic floor have been there and done that. Today she'll talk about pregnancy aches and pains, what's normal, what's not, and how to prepare your pelvic floor for childbirth, postpartum and beyond. So welcome Sarah, Hi, Heidi, Thanks for having me, Thanks for being here. And I have to

say our vaginas and pelvic floors also, thank you. Happy to be of service. I have to say it's the first person to say penis on national televisi. I'm really jealous about your title. How did you become the vagina Whisperer? So it was actually a title given to me, so um. I started in the field of pelvic floor physical therapy right out of grad school in two thousand seven, and there weren't a lot of pelvic floor physical therapist back then.

And I would see my college friends every summer and I would end up in the hot tub with their moms talking about bladder issues and leakage. And all of my friends said, she's like the vagina whisper. And then when I started my Instagram account a few years later, it was for that group of friends. So I kind of started, you know, just as a joke, and then here we are, you know, four years later. Today we're going to focus on caring for your pregnant pelvic floor

and all the wise in house. But before we get into that, can you give us just a little bit of pelvic floor? One oh one? Like, what's down there on the floor? Why is it there? Why do you needed? I mean, is it a case of you don't know what you god till it's gone. So a little bit of all of those things, And I think this is a great place to start because a lot of people don't know what is the pelvic floor, what does it do, and how the heck is their physical therapy for it.

So all people have a pelvic floor, female, male, all genders, and the pelvic floor is actually a basket of muscles that sit at the base of the pelvis. So we're all familiar with, you know, the bones of the pelvis, but at the very basis a hammock of muscles that support your organs like your bladder, your rectum in females uterus and ovaries and males to prostate, and those muscles support those organs and they also have stinkers that help hold in p hold in poop and then assist with

vaginal birth and vaginal intercourse. So how do you know if you need to see a pelvic floor therapist? Is it something that should be routine for all pinnor women? Is it covered by insurance? Is it something your your doctor should refer you or your midwife? Right, so, you know, we see folks coming in if they find us online, if they hear about us from our friend or oftentimes referred by physicians O b G, y m s and midwives.

The way that you should see one is that if you have any issues with bladder health like urinary leakage, overactive bladder difficulty emptying your stream, chronic urinary trucked infections, pooping issues like constipation, fecal incontinence, or sexual health with respect to painful intercourse or the inability to have intercourse

or painful orgasms. So the muscles play a role in bowl health, bladder health, and sexual health, but they also go through a huge transformation during pregnancy and birth, as you and I both know. So that's really where I feel like physical therapy should be standard care for women during pregnancy to prevent issues, help them prepare for childbirth, and then postpartum to help with recovery. So helveic for

physical therapy really falls under physical therapy. So if your insurance covers physical therapy, which most of them do, and you find a clinic that does take insurance, and you can absolutely go and see a physical therapist and it's covered under insure rents. Oftentimes some clinics or what we call out of network, which means they don't contract with insurances, but we provide you or receipt or what we call a super bill that you can send into your insurance

for out of network reimbursement. So there are a lot of options out there to help support moms if you have insurance, and also if you're working with a therapist who doesn't accept it. And you know, I talk a lot about keygels, and in fact I'm doing them right now because I can't talk about them without doing them. But can you explain from a physical therapists perspective, how keegel's work, who they're right for, and how we can

make sure we're doing them correctly. It's a great question that could be an entire episode because but to start with the basics. Keegels are contractions of the pelvic floor. So when we think about a muscle in our body, like our bicep, you bend your elbow and your bicep contracts with the pelvic floor. A kegel is like you're squeezing and lifting that hammock of muscles. So you're closing the sphinc or where you're an exit, closing the anus where gas or poop exits, and kind of you know,

lifting up. My favorite queue to tell people is think about your sipping up a smoothie with your vagina, because it's not a tightening, it's really kind of a pulling up and lift and it's a totally weird que but it somehow works. Um, So you know, that's just strengthen the pelvic floor. And you bring up a great point, Heidi, that not everybody maybe needs to do strengthening. A lot of us have weakness, but a lot of us also have tension, and kegels would not be the appropriate exercise

for that person, so they need to relax instead. Yes, and I would say that a lot of folks out there have pelvic floor attention and need to relax before they start strengthening. That's a great point. Does that mean that a mom moves already had a baby or two will benefit more from keegeles than the first time mom that.

I think it's hard to say. We do know that more often we have weakness postpartum, because again, if we think about those muscles like a hammock, a hammock holding an avocado and week ten is different than hammock holding a watermelon in week forty. So just by the course of pregnancy, our muscles get lengthened and relaxed and aren't as supportive or strong. However, again, a lot of folks still have tension after a cesarean birth, after paraneal tearing,

there can be muscle tension. Um Again, keels may not be the first thing to start with. So we see second time moms a lot who want to prepare for birth. Oftentimes they have weakness, but then they also may have tension and want to kind of just prevent some issues along the way. So we've talked about just about every pregnancy symptom at some point in this show, and I can say pretty much most of them suck. Most of

them are not a fan of pregnancy symptoms. UM. Maybe with the exception of bigger boobs or better hair um, but a lot of the hair. The hair is definitely a good side effect of pregnancy. But let's get into some of the symptoms that might be impacted by your pelvic flour. And of course there's peeing, and there are lots of reasons why you p up a storm when you are pregnant. I mean, there's all those hormones. There's the position of your uterus, which is one of the

reasons why you piece so much early in pregnancy. And you know, if you're peeing a lot, or you have that urgency all the time, or you're having burning sometimes you might have a U T I. So there's lots of different reasons. But what is normal and what is not when it comes to pregnancy p and how is it related to your pelvic floor? Yeah, urinary function is a big one when it comes to pregnancy, and we often do find ourselves going more often again because of

pressure on the bladder, more fluid in our bodies. Urinary leakage is a common symptom, but I wouldn't say it's a normal symptom. So when you start experiencing urinary leakage with a call for a sneeze or with exercise, it's those muscles aren't holding in p as well as we would want them too, So that means there's a muscle issue.

And that's when I would really say start working with a physical therapist, because that means that's not necessarily going to get better after childbirth and then postpartum, and so it's something that you want to start addressing what it happens, and it won't necessarily just go away. So I think urinary leakage is probably the most common. Another common issue

is prolapse. So this is sounds scary, and it's not as scary as it sounds, but the bladder shirts to kind of drop down a little bit into the pelvic floor muscles, so it feels like pressure, heaviness, something's falling out. That's again common because of all the pressure from above, or if we have a high intensity athlete who does running and jumping, it's just more pressure over time. That's another common bladder symptom that people may experience. How common

is that and how would you know? So we go often based by symptoms and then of pressure, heaviness, back pain, it feels like there's a tampon in your vagina when there isn't And then we do a pelvic floor assessment where we look through the vaginal opening, asked them to bear down, and we can often see the kind of the wall of the vagina where the bladder is supported

kind of pushing through. So you can tell by symptoms and then again confirm with an evaluation, because lots of pregnant women and you know, when they reach you know, maybe thirty five, thirty six weeks, they're feeling that pressure anyway, they're peeing a lot again anyway, but the leaking. Is there really a way to train a pregnant bladder to do new tricks like cold in p you'd be surprised

how to the pelvic floor can always do new tricks. So, I mean, it's it's gonna be hard, But I think a lot of what we want to do is help prepare women also for postpartum. So teach them to contract, tighten those pelvic floor muscles before a call for a sneeze, so they get in the habit of doing that, so postpartum they already have that maneuver in place. Teaching them how to pee without pushing, So a lot of times.

A lot of moms are power peers, which means they sit down and they like push really hard when they pee, and that can cause more weakness so in muscles that may already be weak. So we teach them to sit and breathe and relax so that they don't cause more weakness to their muscles. So teach them a lot of really basic things that maybe no one's ever taught them, but can help prevent issues from getting worse as well. Huh,

that's a lot of new tricks I just learned. Although I'm not sure I ever pushed when I was paying. I'm gonna have to think about that. So speaking of things that are literally impacted by pregnancy, of course, you know where I'm going. Constipation, Yes, and it's there for a good reason. It's a purposeful symptom like most are in pregnancy, and that's the slowing down of digestions so your baby can absorb more nutrients. Also, you might be

taking iron, and iron can be constipating. And you know, we know all about and we've heard over and over about staying hydrated and eating the right foods, you know, foods that are high end fiber, taking magnesium, but well, we often don't talk about is how the pelvic floor is associated with pooping, and clearly it is, so would you like to enlighten us a bit us? And I love talking about poop because I don't think we realize the you know, no pun intended impact it has on

our health. I mean, if you take a good poop, you're the rest of your day is can be amazing. But if you don't take a good poop, then you're like, all right, I'm already grumpy and it's eight am. So you know, your pelvic floor muscles, just like with your bladder, your pelvic flor muscles have to relax in order to empty the balls where poop is kind of stored, and if those muscles are not relaxing, well, it will get

backed up. What happens during pregnancy is again your colon is slowing down, the poop gets really hard and difficult to empty. So now I've got this really painful baseball of poop and your muscles aren't relaxing to get it out, and it can be excruciating. And that's another thing that

can lead to hemorrhoids, to fishers, to prolapse. So all of the tips you mentioned probably taking natural call magnesium is one of my favorites, staying hydrated, you know, avoiding constipating foods, but a lot of us want carbs and sweets and things like that. But the proper way to poop is also helpful. So we teach folks to put a little stool under their feet when they're pooping, so that their knees get above their hip heights, so it puts you in a squat, which is the best position

to relax your pelvic floor. And then we also teach them to exhale when they're pushing poop out versus holding their breath. When you hold your breath, you almost tighten up a little bit, which makes it harder. So we teach them to exhale and breathe out with their feet on that stool. And that can make a huge difference during pregnancy pooping. And it's really easy to remember because stool for your stool, stool for your stool. You got it.

I would say everybody hurt sometimes, right, but pregnant women seems to hurt a hole up more than anybody else, especially in the third time ster that load you're carrying gets bigger and heavier and pregnancy can be a pain, a lot of pains. Yeah, it's a pain with a purpose because your body is getting ready for childbirth. But that's still must we accept it. Why does it happen? What can we do about it? That is such a great question, and you really nailed it that we don't

have to accept it. I think so often we hear that leaking part of pregnancy, back pain, part of pregnancy, pooping problems. But there are so many things that we can do to help that we're just not automatically made aware of. And that's where I think physical therapists are really trying to advocate that there is support and help for people during pregnancy. So we talked a little bit earlier about the pelvis as that ring of bones and

then the muscles are at the very base. Well, you have your abdominal muscles in the front, which we know are getting stretched out, lengthening and offering you less support during pregnancy, which can contribute to back pain and postural changes. And you also have little ligaments in that pelvis in the very front at the pubic bone and in the very back at the sacrum, and those ligaments are getting softer.

Because we want the pelvis to expand to accommodate the growing baby, but that also means a little less stability, a little more loosey goosey joins, and that can cause pain with you know, getting out of bed, rolling over, getting out of the car, you know, bending over to pick up a toddler. And there are things that can help. We really encourage people to learn how to use their core muscles when they're doing those day to day activity, so kind of doing a little pelvic floor and pulling

in their bellies to give them some core support. We also teach people how to get out of bed so they're not like hiking up with their abs, they're rolling to their side, and you know, how to get out of a car by keeping their knees together so that not stressing the pubic bone. And then also I really encourage folks to wear these little belly supports, you know,

that is so helpful. It's literally just like a little back breath or a little belly support, but it takes some of the weight off so that you're not carrying this heavy load all the time and you have something

that can help make it more comfortable. So that can definitely give your backup break Now, the hip pain, especially at night, is super uncomfortable for a lot of bombs and getting into a comfortable sleeping position, which you would say is lying on your side with a pillow between your knees down to your ankles, so it's kind of

sandwich the whole way through your shins um. I like to have one to two pillows under your head, so sometimes we need a little bit more support under the head, a little small pillow underneath a belly, especially during the third trimester. And then I always needed something behind my back. I tended to roll into my back a lot, so when I would kind of get into my cozy position on my side with all of my pillows, i'd have

my partner like shove a pillow behind my back. So if I kind of rolled over in the middle of the night, I was just still like sideline a little bit versus all the way on my back. So that just gave me some more options. And again, if that hip is in a position where it's kind of cranked forward, or you know, your knees are pressed together, over time those muscles get tight and tense, which can lead to hip paint. But using some pillows for adjustment really help.

Was there room for your partner on that bed with all those pillows? We got a bigger bed. Okay, good, we upgraded to a king Okay. So um, what exercises should pregnant women avoid that might exacerbate those pains in the back end? Hips? Are there any you can really exercise all throughout pregnancy? Some things to start avoiding kind of right around the second trimester, or crunches, double leg list when you're lying on your back, most exercises lying

on your back. We try to encourage you to lie on your side just to avoid any compression down on you know, your vessels down below baby, but really holding off on anything that causes that kind of sit up maneuver with your abdomen because that will cause it to stretch and lengthen and sometimes lead to a separation called the diastasis recti, which looks like a little football or coning at the midline of your belly. So that's helpful.

And then you know modifications if you're doing planks, you know, get down on your knees and do planks. If you're doing push ups, to them on the wall instead of the ground. And then avoiding like deep lunches, where you might stress some of those joints that are a little bit more lax. Like we talked about earlier, a lot of moms complain about severe pain in their pelvis in their hips, and how do you know when it's time to get help for that. I always recommend by the

way that you go see a pelvic for therapist. That's always my go to. But how do you know it's not something more serious like pelvic girdle pain that can be excruciating. I feel like your entire pelvis is ripping apart.

So a little bit about that, absolutely, and ideally I think this is where we want to change the narrative for pregnant moms that if you are having sciatic pain or pubic bone pain, we know that, Okay, let's send that mom to see a pelvic PT and literally within one to two sessions it can be such a quick fix so they don't get to the point of debilitating pain.

But my rule of thumb is if something is, you know, painful, and it's causing distress in your life, if it's causing psychological or physical angst changes and it's affecting you, then it's worthy of your attention. It's worthy of you seeking care for it. A lot of the times, I think, you know, I can speak for myself as a woman, as a mom, I think I just have to deal

with stuff and I don't have time for it. But when it starts impacting my quality of life of socializing with friends or having endemoucy, use my partner, playing with my kids, that's something that I really should be addressing, no matter if it's a one out of ten pain or a ten out of ten pain. Absolutely, and you know you can be strong but still ask for help. Yes, I think that that's really what takes strength, is saying

I need help exactly. You can use that in you know, when it comes to pains, when it comes to other pregnancy symptoms, that also when it comes to your emotions, don't forget you can be strong and ask for help. Absolutely, painful sex. There are reasons for painful sex that really you know that might not be involving your pelvic muscles. Maybe you have an infection for instance, you know, having had sexual trama in your life that can cause painful sex.

Is this something that you hear about a lot? You know, the research is really showing us that one in four women will experience painful sex at some point in their lifetime, which is a pretty astounding number. And I think I share that to let women know that it's much more common than we realize, and we're just not talking about it. And we read a lot that you may have increased libido or increased sexual desire or more vaginal lubrication during pregnancy.

But if you're not having that and you even have pain, you start to think, is something wrong with me? Is everybody else like this? And some of the common causes we see of painful sex or some of the things you already mentioned hip pain, back pain, it's difficult to get into some of those positions and just kind of

awkward and uncomfortable. The other thing is muscle tension. You know, these are muscles that if they are tighter tense, it's gonna make it difficult for something to enter the vagina. It can feel like something's getting bruised or is tender. With deeper insertion, you can have pain afterwards, so that can be uncomfortable. And even if they're scar tissue from a previous cesarean birth or a previous perennial tear, that can also be a cause of pain even during pregnancy.

So if one and for experience it probably far fewer actually get treatment for it. In that right, it shouldn't have to hurt. It should never hurt. And you know, I think even we start to think, oh, well, maybe it's a little bit normal, but it doesn't necessarily just go away. I mean, I am a pelvic for physical therapist. I've had two kids, and even this year I started experiencing painful sex and I was like, Okay, I need to go see one of the therapists in my office.

I need to get worked on I've been doing too much cycling. And it was you know, four sessions. But and I was so grateful that I knew this, But it goes to show you. You know, everyone's pelvic floor is susceptible to pelvic floor issues. We just don't always know where to get help. So um, it should not hurt. And if you are having pain with sex, I would encourage you to report it to your medical provider and

seek the help of physical therapists. Certainly men would if they had painful I think about that all of the time, and even with respect to like periods and menstrual health, and like if a quarter of their lives were affected by their periods or something in their public floor, it would be a different story. I'm not male bashing, by the way. I'm just supporting my mom's sisters here. I'm

with you now. The separation that you spoke of, a lot of people associate the separation of your abdominal muscles with a postpartum sometimes gets diagnosed, sometimes it doesn't even but you mentioned um doming and coraine shapes, which you can also get when you're having bracts and hicks. Though, so, how do you know the difference, How do you know you have a separation, and is it too early to

start thinking about healing it? So during pregnancy, one of the telltale signs is that you know, I tell we have people lying on their back and they do a little curl up. Their legs are straight, they're lying on their back and they curl up their head and shoulders off the ground. And if you look down at your tummy and you see like a little cone in the middle, you'll know exactly what it looks like. It looks like a little red loaf in the middle of your tummy.

That's likely a separation of your abdominals and there's a little bit of pressure coming through behind it, So it's common. There's research to show seventy to ninety Some studies show a hundred percent of women have it during pregnancy, which I think that that's a little bit of inflated number, but it shows us that the pressure isn't being managed well. And I think about diastasis rector your abdominal separation the same way I think about proaps or pelvic floor weakness.

The hammock is getting stretched. But are there things that we can avoid to minimize that, Not doing the sit ups, not getting out of bed, curling up, you know, watching your core exercises, and then learning to kind of tighten and engage those muscles during day to day activities when they could be getting stressed. You know, that's one way, and then Brexton Hicks is a little bit later. We

typically have that happening during third trimester. The Brexton Hicks would just be showing you that it's there versus it causing it. So it just kind of shows you, well, there's more pressure in the tummy. You may see it happen. Yeah, they are not fun sometimes not fun. Ever, I don't think that's true. That's true. Well, they can be entertaining to watch, like at least they were for me, but they definitely were not fun to experience. So you also

work with women on how to prepare for birth. Yes, what do you think helps most when you're trying to get your body ready for the big day? Should you get a birthing ball, should you do stretches? What are your best tips? So I think a patient of mine actually put it best when she said, gosh, it's actually nice to learn what to do before you actually have

to do it. And during birth, what we are asked skiing women to do, our birthing person to do is to relax their pelvic floors and open them up so that a baby can come on down the birth canal. But if we've never been taught, first of all, we don't even know that there are muscles down there sometimes, and if you've never been taught how to relax them and voluntarily push them open, and you're in the middle of this really vulnerable birthing situation, it's a really difficult

thing to do. So during our childbirth preparation and we do this virtually and we also do it in person, is that we teach women a couple of things. We do. Teach them how to do parenneal massage, which is kind of softening the tissue at the base of the vaginal opening. That's in an effort to just help relieve some muscle tension if they do have tightness down there or some previous card. Can we talk about that real quick before

you may do it? Sounds like a crowd pleaser, you know, massage peneum, but lots of moms just can't get behind the idea. Can you just give us a little tutorial on peranneal massage and would you say it's a d I Y project or you know, should you enlist a

friend kind of thing? Both you can do both, so you know, at the start of COVID a year ago, we actually did an online course teaching people how to do this because all of the childbirth classes were canceled and so it really showed us that, wow, people really don't know how to do this. And the paradeum is the area between the vaginal opening and the anal opening.

There are a lot of nicknames for it. However, the way you massage the paradeum is actually by inserting a finger into the vaginal opening and pushing down, so you're kind of pushing into that muscle through the vagina. And I like to think about the vaginal opening like a clock, so you're thinking about from three o'clock all the way to nine o'clock that lower half. You insert your finger and just kind of push at different points in those clocks, pull down, take a couple of deep breaths. It will

feel a little bit burnie. Once that burning starts to soften and the muscle relaxes, you go to another spot between three to six until you can kind of sweep all the way across, almost like you're making a little smiley face. I have folks do it starting around thirty four weeks of IVAN. See. You can do it to yourself. Um, you can do it while you're in the shower with one leg up and like that Captain Morgan position. Or you can enlist a partner and friend and have them

do it to you as well. So a lot of options, and it's not a must. You know, the research is showing it's variable the effectiveness. But I think any way that we can learn how to connect with our bodies, learn how these muscles work, is beneficial, and you know you will be using these muscles. I mean, unless you have a c section, but still those muscles are impacted.

So I feel either way you win. I agree. I agree, And it's something commonly performed during childbirth, so it's it's also helpful for them to know what to do prior to birth exactly. And if nobody's giving you a perennial massage during childbirth, should you ask for one? Is that one of the best reasons to have a duela for instance? You know, I think if it's something that you feel like is effective for you, I don't see why not asking.

Other things that have been helpful to soften the pyreneum are using a warm compress or even a warm wash cloth over the area. Uh. And again, you know, back to what we teach women what to do to prepare for birth, as we teach them how to breathe when they're pushing, we're finding that a lot of folks are holding their breath when they're pushing, and that's not helping the muscles relax to get out of the way. And

so we're teaching them to push while they're breathing. They're not exhausted or they're not giving themselves hemorrhoids and prolapse, and they feel like they can effectively relax these muscles. Your pelvic floor muscles don't push your baby out. Your uterus does. And we just want the muscles to get out of the way. And so that's what we're trying to help women do well. I guess that's a wrap for pregnancy. We just had the baby leave the building, so we're gonna pick back up with you when it's

time to talk postpartum. But we can't thank you enough for being on today with What to Expect community. This is so great. Thank you so much. Thank Sarah, baby baby Off, need you, Oh how I need you. Thanks for listening. Remember I'm always here for you. What to Expect is always here for you. We're all in this together. For more on what you heard on today's episode, visit

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